Thesis (Ph.D.)--University of Melbourne, Centre for Neuroscience and Howard Florey Institute, 2009. / Typescript. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (D.Min.)--Florida Center for Theological Studies, 2008. / Includes bibliographical references (leaves 179-182).

Thesis (M.S.)--University of Michigan, 1985.

The thesis deals with a definition of pain management issues, role of nurses working with patients in pain and, particularly, perception of pain of patients by nurses. The objective of the research was to identify and to study pain management procedures and, at the same time, to present how nurses perceive and experience the care of patients in pain. The empirical part of the thesis was performed through qualitative investigation using semi-structured interviews with nurses and patients. The respondents included 12 nurses and 8 patients. Based on results of the investigation covert participatory observation was selected as a complementary method. 6 nurses were observed while taking care of patients during a post-surgery period. Most frequently, nurses rate pain of patients by means of VAS (Visual Analogue Scale), however, they quite often assess the value subjectively. Nurses then record the found values regularly into the patient´s chart. Nurses would also appreciate more cooperation with physicians in order to increase efficiency of pain rating. Nurses are able to respond very well to patient´s verbalization of pain and they perceive differences in communication in such situations. The majority of nurses choose pro-active approach to pain alleviation. Nurses have the basic knowledge about non-pharmacological pain alleviation. Perception of pain by nurses is partly affected by length of their practice and by their own experience with pain. Nurses perceive negatively those situations when pain management interventions are not sufficiently effective, when they cannot contact physicians or when they cannot act based on their own discretion. In such situations nurses demonstrate signs of distress. This problem aggravates when nurses work with patients suffering from chronic pain. Nurses have only limited opportunities to improve their education in pain management and communication with patients in pain. Patients in pain mostly see the care provided by nurses positively but they have also provided numerous recommendations for the nurses. The empirical research has shown that nurses meet with patients in pain nearly every day while performing their nursing practice and that assessment of pain plays an important role in pain alleviation. In most cases the exposure of nurses to patients in pain causes their negative emotional experience, such as sadness or fear of complications. Their experience is affected by several factors. In general, the issues of pain perception by nurses in comparison with pain management techniques are often neglected. Nevertheless, from the viewpoint of mental stress, pain perception is an indisputable factor that deserves more detailed investigation.

Dor pélvica crônica é comumente descrita como uma dor contínua ou intermitente na pelve anatômica ou parede abdominal anterior, em nível ou inferior ao umbigo que dura pelo menos seis meses, e é suficiente severa para causar incapacidade funcional ou para levar a procura de cuidados. A etiologia não é clara, e resulta numa complexa interação entre os sistemas gastrointestinal, urinário, ginecológico, músculo-esquelético, neurológico e endócrino, influenciado ainda por fatores psicológicos e socioculturais. O exercício físico tem sido descrito como um ótimo meio para tratar doenças crônicas músculo-esqueléticas, viscerais e neuronais. Existem vários indícios que o exercício físico, tanto aeróbio quanto anaeróbio promovem aumento do limiar de dor em pacientes com dor crônica. O objetivo deste estudo foi inserir o exercício de resistência de força em 21 mulheres com dor pélvica crônica e 21 mulheres saudáveis (grupo controle), para saber se por meio do mesmo era possível aumentar o limiar de dor (diminuir a dor), e se existia alguma relação entre o limiar de dor e os parâmetros cardiovasculares. O exercício selecionado foi a máquina \"cadeira extensora\", sendo feito quatro séries de quinze repetições com pausa de um minuto entre cada série, com duração de dez minutos no total. Após a fase de adaptação, a intensidade do treinamento foi de 40% de 9 repetições máximas nas duas primeiras semanas e 60% de 9 repetições máximas nas duas últimas semanas, totalizando 4 semanas. Também foram avaliados os níveis de ansiedade e depressão (PHQ-4), cinesiofobia (Tampa), intensidade da dor (escala visual analógica), tipo de dor (DN4) e catastrofização da dor (escala de catastrofização da dor), além de frequência cardíaca e pressão arterial. Todos os instrumentos utilizados foram traduzidos e validados para aplicação no Brasil. O projeto, juntamente com o termo de consentimento livre e esclarecido, foi aprovado no Conselho de Ética do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, da Universidade de São Paulo. Foi observada uma correlação inversa nos limiares de dor entre os grupos, demonstrando que mulheres com dor pélvica crônica diminuem os limiares periféricos de dor após o exercício selecionado (p<0,005). A pressão arterial e frequência cardíaca se mostraram com basal aumentadas no grupo dor pélvica crônica, com possível interferência da pressão arterial sistólica. A frequência cardíaca não demonstrou retornar a linha basal após o término do treinamento. O estudo demonstrou que mulheres com dor pélvica crônica possuem limiar de dor diminuído após o exercício, quando comparado a fase pré exercício e quando comparado a mulheres saudáveis. Os parâmetros cardiovasculares (frequência cardíaca e pressão arterial) se mostraram alterados em dor pélvica crônica ao comparar com mulheres saudáveis, levando a hipótese de que o sistema cardiovascular possuí correlação com os limiares periféricos de dor. / Chronic pelvic pain is commonly described as continuous or intermittent pain in the anatomical pelvis (anterior abdominal wall at or below the umbilicus) that lasts for at least six months, and is severe enough to cause functional disability or to lead to the search for care. The etiology is unclear, resulting in a complex interaction between the gastrointestinal, urinary, gynecological, muscle-skeletal, neurological and endocrine systems, still influenced by psychological and sociocultural factors. Physical exercise has been described as a great way to treat chronic musculoskeletal, visceral and neuronal diseases. There are several indications that physical exercise, both aerobic and anaerobic, promote an increase in the pain threshold in patients with chronic pain. The purpose of this study was to insert the strength endurance exercise in 21 women with chronic pelvic pain and 21 healthy women (control group) to determine if it was possible to increase the pain threshold (decrease pain) and if it existed some relationship between the pain threshold and the cardiovascular parameters. The exercise selected was the \"extensor chair\" machine, with four sets of fifteen repetitions with a one-minute pause between each series, lasting ten minutes in total. After the adaptation phase, training intensity was 40% of 9 maximum repetition in the first two weeks and 60% of 9 maximum repetition in the last two weeks, totaling 4 weeks. The levels of anxiety and depression (PHQ-4), kinesiophobia (Tampa), pain intensity (Visual analogic scale), type of pain (DN4) and catastrophic pain (PCS) and blood pressure. All the instruments used were translated and validated for application in Brazil. The project, together with the free and informed consent form, was approved at Conselho de Ética do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, da Universidade de São Paulo. An inverse correlation was observed in pain thresholds between the groups, demonstrating that women with chronic pelvic pain lower peripheral pain thresholds after the exercise selected (p <0.005). Blood pressure and heart rate were shown to be increased basally in the chronic pelvic pain group, with possible interference from systolic blood pressure. The heart rate did not demonstrate a return to the baseline after the end of the training. The study showed that chronic pelvic pain women have increased pain threshold after exercise when compared to the pre-exercise phase and when compared to healthy women. The cardiovascular parameters (heart rate and blood pressure) were altered in chronic pelvic pain women when compared to healthy women, leading to the hypothesis that the cardiovascular system has a correlation with the peripheral pain thresholds.

Exercise-induced hypoalgesia (EIH) denotes the phenomenon wherein physical activity induces a diminished sensitivity to pain, holding significant implications for pain management modalities. This investigation sought to evaluate the reproducibility of pressure pain thresholds (PPT) subsequent to dynamic resistance exercise and juxtapose PPT measurements during periods of quiet rest against those immediately post-exercise. A cohort of five healthy participants underwent three separate sessions, wherein PPT assessments were conducted pre- and post-exercise. Findings revealed a nuanced reliability in PPT measures during EIH evaluation, necessitating judicious interpretation due to the constrained sample size. Comparative analyses with antecedent research underscored discernible disparities in exercise intensities and methodological approaches, accentuating the imperative of considering idiosyncratic responses and procedural distinctions. Despite inherent limitations, notably the modest sample size, this inquiry furnishes valuable insights into the intricacies of EIH assessment, elucidating the complexities inherent in advancing knowledge within the domain of pain modulation research. Prospective investigations with larger and more heterogeneous cohorts are imperative to fortify the dependability and generalizability of findings in this realm.

Title: Efficiency of cold treatment of locomotive system dysfunctions Objectives: The theoretical part should provide an overview of effects of cold on the human organism. The practical part reports a pilot study in which local cryotherapy was applied to painful areas of dysfunctional locomotive system. Methods: After measuring local painfulness using an algometer, the Cryogen 2 device was used for local cryotherapeutic treatment; after the treatment, algometer was used again. Subjective state of the patient was monitored throughout the process. Cryotherapy was applied within normal individual physiotherapeutic treatment to patients of varying age, sex, and locomotive system dysfunctions. Results: We have shown that local cryotherapy, using the Cryogen 2 device, did decrease painfulness in measured areas. Although significant differences in pain perception were found between male and female patients, the efficiency of cryotherapy did not depend on sex. Some correlation was found between treatment efficiency and age. No evidence was found for establishing that repeated application decreases pain perception measured before the next treatment. The results are influenced by a smaller sample of patients and measurements, and by inhomogeneity of patients. Key words: pain treatment, cold, local cryotherapy,...

The thesis focuses on the history of pain treatment from the beginning of humanity to present days. It aims to provide a comprehensive overview of the research development, creation of theories and struggling of a man with the pain, an unpleasant sensory perception, without which the mankind would most probably not survive. From the skeletal remains we learn about pain-killing practices among primitive people who were, besides various potions, charms, spells and rituals, able to use even the trepanation techniques. We find that people in ancient times apparently understood the pain caused by traumatic mechanisms but they could not handle the pain caused by some internal disorder. Early findings about the treatment of pain were thus linked to the nature. People used plants with narcotic and analgetic effects e. g. opium, cannabis, mandrake and physical quantities such as pressure, heat, cold or even shocks generated by electric fish. Over the time they improved this knowledge and reached for new findings. This thesis presents also ideas and creation of theories of pain provided by thinkers and scholars across centuries. Works from antiquity had apparently the biggest and the longest lasting influence on pain and medical problematics. From historical sources we read that new discoveries in medicine...

Background: Altered autonomic nervous system (ANS) function has been proposed as a mechanism in the development of central sensitisation (CS) and visceral pain hypersensitivity (VPH). The contribution of the parasympathetic nervous system (PNS) and the factors that mediate differences in sensitisation to acid are unclear and their study will clarify risk factors for oesophageal pain hypersensitivity (OPH) in gastrooesophageal reflux disease. Aims: To investigate psychophysiological and pharmacological manipulation of PNS tone in the development of OPH, and to determine factors which predict the development of OPH to acid infusion in healthy volunteers in a validated model of acid induced OPH. Methods: Pain thresholds to electrical stimulation in the proximal oesophagus were determined before and after a 30-minute distal oesophageal infusion of 0.15 mol/L hydrochloric acid in subjects. Sympathetic (SNS) and PNS parameters were measured at baseline and continuously thereafter. Subjects underwent psychological profiling for anxiety, depression, attachment vulnerability and personality type. Using this model, five studies were undertaken: Study 1 a pilot study to trail modulation suitability for further study used. In Study 2, subjects who demonstrated secondary hyperalgesia in the proximal non-acid-exposed oesophagus performed deep or sham breathing. Study 3 subjects, who did not sensitise to acid, underwent a validated stress test to induce OPH. With Study 4, deep breathing with IV saline (placebo) or atropine (PNS antagonist) was used to evaluate deep breathing’s induced PNS tone in OPH reduction. Study 5, a genetic pilot study, exploring the role of the GCH-1 haplotype in VPH. Results: ANS control’s key role in CS was clarified. Deep breathing increased PNS tone and prevented acid-induced OPH in comparison to sham breathing and confirmed increased PNS tone’s reversal of OPH. Psychological factors of anxiety, alexithymia and attachment status influence ANS modulation of CS. Individuals’ predisposition to VPH due to psychogenetic profiles were clarified and their biopsychosocial role illustrated. Conclusions and Inferences: A mechanistic explanation for the analgesic effect of deep breathing is provided with potential therapeutic implications in the treatment of VPH syndromes. Further clinical study is warranted to develop cost-effective treatments for chronic VPH syndromes.